An Introduction to Evidence-Informed Public Health and

A Compendium of Critical Appraisal Tools

for Public Health Practice

Donna Ciliska • Helen Thomas • Cathy Buffett

February 2008
An Introduction to Evidence-Informed Public Health and

A Compendium of Critical Appraisal Tools

for Public Health Practice
Donna Ciliska • Helen Thomas • Cathy Buffett
Acknowledgements:

L. Buffett, K. Barnett

February 2008
Contact:
D. Ciliska
ciliska@mcmaster.ca
905-525-9140

National Collaborating Centre for Methods and Tools (NCCMT)

School of Nursing, McMaster University
Suite 302, 1685 Main Street West
Hamilton, Ontario L8S 1G5
Telephone: (905) 525-9140, ext. 20455
Fax: (905 529-4184

Funded by the Public Health Agency of Canada

Affiliated with McMaster University

Production of this paper has been made possible through a financial contribution
from the Public Health Agency of Canada. The views expressed herein do not nec-
essarily represent the views of the Public Health Agency of Canada.

3
Summary
Purpose
This background paper defines and summarizes the concept of Evidence-Informed Public Health
(EIPH) recognizing that, to use evidence in public health practice and policy development, one must
first critically appraise the available research that provides the basis for that evidence.

This paper addresses the need for critical appraisal of primary research studies and systematic
reviews to inform effective public health practice. It also outlines a hierarchy of quality of research
evidence that can be used to inform public health policy and program delivery.

For that reason, this paper presents some of the more commonly used critical appraisal tools. These
tools provide basic guidelines and checklists for public health professionals to evaluate the quality of
research when reading the literature. Web links in the compendium that accompanies this paper will
direct users to some of the most current and usable tools.

Methods
Relevant literature collected and reviewed for this background paper comprises all literature (grey and
published) used for the environmental scan for the National Collaborating Centre for Methods and
Tools (Ciliska et al., 2006), including an update of that literature, and a review of relevant references
and websites.

Conclusions
The highest quality evidence available is vital to the interactive process of moving knowledge into
practice in the complex world of public health; however, the time constraints typically faced by public
health practitioners can preclude a consistent implementation of the principles of evidence-informed
decision-making. Critical appraisal provides an efficient method of reviewing evidence for its quality,
and is an important part of the process of evidenced-informed practice and policy development. The
use of quality checklists and other tools can provide a systematic and effective means to help identify
rigorous studies with valid conclusions for potential implementation and assessment.

5
An Introduction to Evidence-Informed Public Health and

A Compendium of Critical Appraisal Tools

for Public Health Practice

Introduction
Evidence-Informed Public Health (EIPH) depends on good sound evidence. Although decisions to
develop and implement new programs and services must be grounded in best practices, the methods
and frameworks needed to inform knowledge and translate evidence into practice are often consid-
ered time-consuming and difficult to understand.

Public health professionals live in a world of heavy workloads, inadequate staffing and insufficient
dedicated resources. Especially in the face these realities, critical appraisal of existing evidence is
fundamental to the search for quality evidence to inform the process of public health decision-making.

Critical appraisal, as described by public health professionals within the Environmental Scan for the
National Collaborating Centre for Methods and Tools (NCCMT) (Ciliska et al., 2006), included the use
of users’ guides to assess the rigor/strength of research; standardized methods of quality assessment
of primary studies and reviews of evidence; and up-to-date and easy-to-use tools to rate the quality of
evidence/research. The compendium of tools can assist with this critical appraisal.

Primary Audience
Primary audiences for this paper include busy public health managers and policy-makers who may
have little or no experience in assessing qualitative or quantitative research.

Literature Search
The comprehensive search for published literature from 1996-2006 is described fully in the NCCMT
Environmental Scan (Ciliska et al., 2006). An update of the initial search was conducted in February
2007. Of the literature collected, 51 articles were retrieved for review. Appendix 3 of the Environmen-
tal Scan (Ciliska et al., 2006) provided a valuable list of relevant websites that were scanned in order
to identify current tools and literature. Personal databases of McMaster faculty who teach courses in
critical appraisal were reviewed to ensure the currency and relevance of available literature and web-
sites. Two other reviews that assessed critical appraisal tools, primarily from the perspective of the
systematic reviewer (Deeks et al., 2003; West et al., 2002), provided additional sources for consider-
ation.

6
Introduction to Evidence-Informed Public Health
EIPH is rooted in evidence-based medicine (EBM), at term coined by Guyatt et al. in 1992
(Cullum et al., 2008). Under Guyatt’s leadership, the Evidence-Based Medicine Work Group
published a series of articles for the Journal of the American Medical Association between
1993 and 2000 that outlined the criteria for evaluating current evidence to support clinical
decisions. These articles formed the basis of most existing critical appraisal tools. Acceptance
for EBM has grown substantially over the past fifteen years among nurses and other health
professionals including public health practitioners (Gandelman et al., 2006; Kohatsu et al.,
2004; Rychetnik & Wise, 2004).

The expansion of EBM to include evidence-based public health (EBPH) (Kohatsu et al., 2004) is
defined as “the process of integrating science-based interventions with community preferences to
improve the health of populations.”

Evidence-Informed Public Health builds on the ideas of EBM and EBPH, but acknowledges the many
factors, beyond simply the evidence, that influence decision-making. EIPH is a complex, multi-disci-
plinary process that occurs within dynamic and ever-changing communities and encompasses differ-
ent sectors of society.

EIPH has several distinct stages: define, search, appraise, synthesize, adapt, implement and evalu-
ate (see Table 1). At each step, there are resources and best practices that can inform and improve
the process. Methods and tools are available to help public health practitioners and policy makers
hone their EIPH skills.

TABLE 1 - Stages in Evidence-Informed Public Health

Stage in EIPH Description

1 DEFINE Clearly define the issue or problem.

2 SEARCH Efficiently search for the research evidence.

3 APPRAISE Critically and efficiently appraise the information sources.

Interpret information and/or form recommendations for practice

4 SYNTHESIZE
based on the relevant literature found.

5 ADAPT Adapt the information to local context.

7
 Stage in EIPH Description

Make a decision about implementing the adapted evidence in

6 IMPLEMENT
practice, program- or policy-development, or decision-making.

7 EVALUATE Evaluate the effectiveness of the implementation efforts.

EIPH does not happen in a vacuum. Figure 1 illustrates the intersecting components of effective
public health decision-making and offers a way to visualize the spectrum of factors to be considered
toward developing and providing the best public health interventions possible. Generic clinical ex-
pertise can provide a valuable understanding of the integration of the components required to make
effective clinical decisions (Dicenso et al., 2005). Effective evaluation of evidence to support public
health practice must address these multidimensional issues.

FIGURE 1: A model for evidence-informed public health decision-making

Community Health Issues, Community and Political

Local Context Preferences and Actions

Public Health Expertise

Research Evidence Public Health Resources

Critical Appraisal – Is the Evidence Good Enough?

It has been estimated that less than 20% of published literature is scientifically sound, leaving health
practitioners with the often overwhelming task of sorting the valid, sound and useful literature from
the invalid and ineffectual (Demaerschalk, 2004; Rychetnik & Wise, 2004). So, how can public health
professionals decide if the evidence they find is good enough? The answer lies in a critical appraisal
of the research evidence.

8
Three questions need to be answered for the purpose of critically appraising research specific to pub-
lic health practice (Rychetnik et al., 2002):

1. Is the research valid, sound and applicable to my situation?

2. What outcomes can I expect if I implement this research?

3. Will my target population be able to use this research?

Critical appraisal tools or checklists can facilitate the process and help practitioners to readily under-
stand why an intervention may appear to be effective in one setting, but ineffective in another (Ry-
chetnik et al., 2002).

Quality Evidence for Public Health Practice

This section discusses the elements to consider when critically appraising evidence for decision-mak-
ing in public health.

Formulating practice/policy questions using the Population,

Intervention, Comparison, Outcome (PICO) formula
There are four elements to framing a question about an intervention program or treatment: population,
intervention, comparison, and outcome (Fineout-Overholt & Johnston, 2005). Outlining the search
terms in the PICO format helps to develop a focused search strategy for collecting the available
evidence for critical appraisal. Table 2 provides some examples of relevant public health research
questions (adapted from DiCenso et al., 2005).

TABLE 2 - Examples of Research Questions Relevant to Public Health

Question Type Example

Can a multi-component obesity prevention program in a sec-

Effectiveness of Interventions
ondary school increase adolescent physical activity?

Diagnosis (Assessment or Can a school-based surveillance program for absenteeism

Screening) over 10% indicate early influenza activity in a community?

What are the health effects in young children due to chronic

Prognosis consumption of private well water containing excessive lead
concentrations?

Are there any long term adverse reactions associated with

Harm
immunization for meningococcal disease in young adults?

9
 Question Type Example

For adult patients who require chemoprophylaxis for tuber-

culosis infection, are office/clinic visits three times a week
Quality Improvement
for directly observed drug therapy as effective as daily home
visits by public health nurses?

Is social marketing for community prevention strategies for

Economic Evaluation
West Nile Virus cost effective in rural communities?

Are there demographic and psychosocial risk factors that can

Clinical Prediction Guide be used to develop a predictive index for HPV infection in
females under 20 years of age?

Understanding the meaning of

What are adolescent experiences of seeking peer-counsel-
health issues; target population
ling for sexual health matters in secondary schools?
experiences, beliefs or attitudes

The following example of an application of the PICO formulation uses the effectiveness question from
Table 1: Can a multi-component obesity prevention program in a secondary school increase adoles-
cent physical activity?

1. Population - secondary school students

2. Intervention - multi-component obesity prevention program

3. Comparison - usual health and physical activity courses

4. Outcome - levels of physical activity/ rates of obesity

Types of Research
EBM was founded largely on quantitative research; however both quantitative and qualitative re-
search contribute important knowledge to public health and can answer different questions of interest
related to public health interventions.

Public health programs and actions must be not only effective, but appropriate for our communities
and target populations. EIPH effectively transfers knowledge from both quantitative and qualitative
research.

An understanding of the factors that support or impede the delivery of public health actions is seldom
found solely in quantitative studies of effectiveness (Jackson & Waters, 2005). Qualitative informa-
tion is critical to determining the community relevance of a program or intervention. It provides public
health practitioners with essential information about the effectiveness of interventions, and the contex-
tual circumstances in which these interventions were delivered or could work.

10
The usefulness of a recently proposed hierarchy of evidence for qualitative research has not yet been
conclusively established (Daly et al., 2007).

Systematic Reviews - Important Keys for EIPH

Systematic reviews identify, appraise and summarize evidence that is relevant to a particular research
question (DiCenso et al., 2005; Rychetnik & Wise, 2004). They are “reviews of clearly formulated
questions that use systemic and explicit methods to identify, select and critically appraise relevant re-
search, and to collect and analyse data from the studies included in the reviews” (Waters et al., 2006)
Expert panels are assembled to collaboratively conduct systematic reviews (Thomas et al., 2004;
Waters et al., 2006) and can consider both quantitative and qualitative research. Whenever possible,
good quality systematic reviews of the evidence, rather than single studies, should be used for public
health practice decisions.

In 1998, the Effective Public Health Practice Project (EPHPP) began to systematically summarize
research evidence to inform public health practice and policy for the Ontario Ministry of Health and
local provincial health units. EPHPP developed a standardized tool to appraise individual studies for
systematic reviews and summarized worldwide collaborative efforts to maintain databases for this
purpose (Thomas et al., 2004). An exhaustive report assessed ways of appraising non-randomized in-
tervention studies (Deeks et al., 2003). Of the 197 tools reviewed, only six were considered adequate
for use in performing systematic reviews; the Thomas tool was one of these six superior tools.

Good systematic reviews or overviews are particularly helpful for busy public health practitioners
because the evidence has already been found, the quality of that evidence evaluated, and the find-
ings summarized for a specific question of interest (Ciliska et al., 2001; Jackson & Waters, 2004).
However, one cannot assume that all systematic reviews are good, and therefore, they too need to be
critically appraised.

Pre-processed Evidence
Pre-processed evidence is an important and readily available resource for public health profession-
als. Pre-processed evidence has already been reviewed for methodological rigour by an individual or
group who has then summarized the best quality evidence for consideration in public health practice.
Systematic reviews, guidelines, EB textbook/journal summaries, clinical decision-making tools all
fall under pre-processed information. Many on-line resources and products are kept current and are
readily accessible.

Databases of pre-processed evidence can be accessed through health-evidence.ca, the Effective

Public Health Practice Project, the Cochrane Library, the Centre for Reviews and Dissemination at the
University of York (UK), the Canadian Task Force on Preventive Health Care, the Guide to Commu-
nity Preventive Services (US) and the Scottish Intercollegiate Guidelines Network (SIGN). SIGN has
produced an excellent workbook to develop clinical guidelines, which includes in its appendices six
methodology checklists (tools) to critically appraise quantitative research studies, economic evalua-
tion and systematic reviews. Links to these tools are included in Appendix 1.

Economic Evaluation
Public health interventions are challenging to evaluate and synthesize because of their complexity,
the possible involvement of professionals from a variety of disciplines, the unique features of the con-
text of the study setting, the characteristics of the study population, and other methodological issues
(Lin, 2004; Rychetnik et al., 2002; Waters et al., 2006).

11
Despite the challenges, decisions to implement new public health interventions or programs (or to
maintain current practices) should be based on methodological economic evaluations (Birch & Gafni,
2003), and not simple cost-benefit analyses. Economic evaluation helps to determine whether the
relative values of different outcomes and consequences of an intervention are worth the associated
costs in both dollars and health risks. Public health practitioners must also evaluate whether the esti-
mated costs associated with effective interventions seem realistic for their local settings.

There are relatively few economic evaluations in public health to date. Appendix 1 contains a link to
the United Kingdom National Health Service Economic Evaluation Database, a free resource that
summarizes evidence and includes an economic evaluation tool.

Meta-Synthesis
Meta-synthesis incorporates the findings from multiple qualitative studies and can increase the
transferability or generalizability of findings for public health practice. Meta-synthesis can enhance our
understanding of the processes involved for the population of interest or for health care delivery, and
inform decision-making for policy and program development.

Considering the Research

Research must always be critically appraised for its methodological rigour The dilemma facing public
health is that a randomized controlled trial (RCT) is not always feasible for a variety of reasons (e.g.
cost, social constraints, ethical issues). Furthermore, as in all areas of health/medicine, not all RCTs
of public health interventions have strong methodology.

Once selected, evidence can be organized or grouped according to its susceptibility to bias (Rychet-
nik & Wise, 2004). A hierarchy of evidence provides a way to rate the quality of evidence, where the
same research question has been studied using different research methods or approaches.

By identifying the strongest evidence, the hierarchy allows practitioners to 1) limit a search and 2)
consider when to weigh alternative approaches or interventions for program delivery in public health.
Table 3 summarizes the hierarchy of strength of quantitative evidence for treatment or public health
interventions (adapted from Dicenso, Ciliska, & Guyatt, 2005).

TABLE 3 - A Hierarchy of Strength of Evidence for Treatment/ Intervention Decisions (Quantitative

Research)
Relative Strength
of Evidence Type of Evidence
(with 1 being the strongest)

systematic review of randomized controlled trials

1

systematic review of observational studies addressing popula-

tion health important outcomes
2

12
 Relative Strength
of Evidence Type of Evidence
(with 1 being the strongest)

3 single randomized trial

single observational study addressing population important

4
outcomes

physiologic and epidemiological study (e.g., study of infection

5
prevalence, prevalence of cardiovascular risk factors)

A hierarchy or order can also indicate the strength of pre-processed evidence (see Table 4).

TABLE 4 - A Hierarchy of Pre-processed Evidence

Relative strength Type of Description
(with 1 being the strongest) Research
practice guidelines, decision pathways,
or evidence-based summaries of a public
health practice that provide public health
1 Systems
professionals with much of the informa-
tion needed to guide the intervention/
action

Synopses of syn- brief summaries of reviews with key

2
theses methodological details and results

an overview of systematic reviews provid-

Syntheses (system- ing public health professionals with all the
3
atic reviews) evidence that addresses a focused public
health question

Synopses of single brief summaries of individual studies with

4
studies key methodological details and results

13
 Relative strength Type of Description
(with 1 being the strongest) Research
those studies selected by an organiza-
tion and pre-processed based on high
5 Single studies relevance and characterized by study de-
signs that minimize bias and thus permit
a high strength of inference

Note: Although samples may have been randomly allocated to either control or intervention groups,
other sources of bias may not have been addressed; for example, researchers may not have imple-
mented the blinding of outcome assessors and/or there may be very high drop-out rates. Given that,
in most interventions, drop-outs are least likely to have accomplished the outcome goal (e.g. quit
smoking, avoid adolescent pregnancy), this can skew the results. Alternatively, some cohort studies
have strong methodology, so excluding them from systematic reviews could be an error.

Tools
This document provides a compilation of selected tools and recommendations for critically appraising
relevant research for EIPH; it does not provide detailed discussion about each of the tools or check-
lists.

Appendix 1 includes a summary of the websites of leading organizations and links to critical appraisal
tools for public health professionals. Recommendations are indicated for the use of various tools by
public health practitioners and policy-makers. Relevant links to current pre-processed evidence are
also provided.

Discussion and Conclusions

Critical appraisal provides a method of reviewing the quality of methods of research articles, as one
step in EIPH. Critically appraised research is needed as part of an interactive process moving knowl-
edge into practice in the complex world of public health. The use of quality checklists and other tools
helps to provide a systematic and efficient means to identify rigorous studies for application to clinical
practice or policy development.

This background document provides a brief discussion of some of the key concepts related to EIPH
and critical appraisal for public health practice. A compendium of resources that are important to
EIPH, including helpful websites and links to relevant tools, can further support the implementation of
EIPH among the target audience.

14
References
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In: A. Dicenso, G. Guyatt, & D. K. Ciliska (Eds.), Evidence-Based Nursing: A Guide to
Clinical Practice. (pp. 3-19). St. Louis, MO.: Elsevier/Mosby.

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clinical questions. Worldviews Evid.Based Nurs., 2, 157-160.

Gandelman, A. A., Desantis, L. M., & Rietmeijer, C. A. (2006). Assessing community needs
and agency capacity: An integral part of implementing effective evidence-based interven-
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interventions. Journal of Public Health, 26, 303-307.

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Jackson, N. & Waters, E. (2005). Criteria for the systematic review of health promotion and
public health interventions. Health Promotion International, 20, 367-374.

Kohatsu, N. D., Robinson, J. G., & Torner, J. C. (2004). Evidence-based public health: an
evolving concept. American Journal of Preventive Medicine., 27, 417-421.

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tradictions. Sozial- und Praventivmedizin, 49, 179-184.

Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence
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and a way forward. Health Promot.Int., 19, 247-257.

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Assessment.

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17
 APPENDIX 1

Compendium of Critical Appraisal Tools

Purpose
To provide some tools for conducting critical appraisal (step 3 below).

Audience
Public health decision-makers in practice or policy.

Introduction to Evidence-Informed Public Health

The Evidence-informed decision-making process includes the following steps:

Stages in Evidence-Informed Public Health

Stage in EIPH Description

1 DEFINE Clearly define the issue or problem.

2 SEARCH Efficiently search for the research evidence.

3 APPRAISE Critically and efficiently appraise the information sources.

Interpret information and/or form recommendations for practice based on the relevant
4 SYNTHESIZE
literature found.
5 ADAPT Adapt the information to local context.

Make a decision about implementing the adapted evidence in practice, program- or

6 IMPLEMENT
policy-development, or decision-making.

7 EVALUATE Evaluate the effectiveness of the implementation efforts.

1
How to use this tool
Consider the type of question you are asking (first column); then consider the type of evidence you have found. That will lead you to
what tool to use.

This is not an exhaustive list of critical appraisal tools; merely a listing of tools that are commonly used.

The status “Recommended,” represented by the , indicates that the tool 1) was judged as relevant for most studies in public
health, and 2) includes an explanation of criteria within the tool, so the use of the criteria are self-explanatory.

Type of Research Website Link Type of Study - Link to Tools

Quantitative Critical Appraisal Skills Programme randomized control trials:

(CASP) (UK): http://www.phru.nhs.uk/Doc_Links/rct%20appraisal%20to
What is the http://www.phru.nhs.uk/Pages/PHD/reso ol.pdf
effectiveness of….? urces.htm
cohort studies:
What is the result of http://www.phru.nhs.uk/Doc_Links/cohort%2012%20quest
exposure to…? Recommended
ions.pdf
(causation or harm)

Guidelines for…? case control studies:

http://www.phru.nhs.uk/Doc_Links/Case%20Control%201
1%20Questions.pdf

diagnostic studies:
http://www.phru.nhs.uk/Doc_Links/Diagnostic%20Tests%
2012%20Questions.pdf

2
Type of Research Website Link Type of Study - Link to Tools

Scottish Intercollegiate Guidelines randomized control trials tool and guidelines:

Network (SIGN): checklist:
http://www.sign.ac.uk/ http://sign.ac.uk/guidelines/fulltext/50/checklist2.html

notes on use:
http://sign.ac.uk/guidelines/fulltext/50/notes2.html

cohort studies tool and guidelines:

checklist:
http://sign.ac.uk/guidelines/fulltext/50/checklist3.html

notes on use:
http://sign.ac.uk/guidelines/fulltext/50/notes3.html

case-control studies tool and guidelines:

checklist:
http://sign.ac.uk/guidelines/fulltext/50/checklist4.html

notes on use:
http://sign.ac.uk/guidelines/fulltext/50/notes4.html

diagnostic studies tool and guidelines:

checklist:
http://sign.ac.uk/guidelines/fulltext/50/checklist5.html

notes on use:
http://sign.ac.uk/guidelines/fulltext/50/notes5.html

3
Type of Research Website Link Type of Study - Link to Tools

Qualitative Critical Appraisal Skills Programme qualitative research studies:

(CASP) (UK): http://www.phru.nhs.uk/Doc_Links/Qualitative%20Ap
What is the http://www.phru.nhs.uk/Pages/PHD/reso praisal%20Tool.pdf
experience of or urces.htm
meaning of..?
Recommended

Reading Qualitative Studies:

Article link (pdf):
http://www.ualberta.ca/~iiqm/backissues/
1_1Final/pdf/sandeleng.pdf

National Health Service (UK)

www.hda.nhs.uk

Systematic Critical Appraisal Skills Programme systematic reviews:

Reviews (CASP) (UK): http://www.phru.nhs.uk/Doc_Links/S.Reviews%20Ap
http://www.phru.nhs.uk/Pages/PHD/reso praisal%20Tool.pdf
What is the urces.htm
effectiveness of…?
Recommended for critical appraisal
of systematic reviews

Scottish Intercollegiate Guidelines Systematic reviews and meta-analysis tools and guidelines:
Network (SIGN): checklist:
http://www.sign.ac.uk/ http://sign.ac.uk/guidelines/fulltext/50/checklist1.html

notes on use:
http://sign.ac.uk/guidelines/fulltext/50/notes1.html

4
Type of Research Website Link Type of Study - Link to Tools

Cochrane Handbook for Systematic Handbook link (pdf):

Reviews of Interventions http://www.cochrane.org/resources/handbook/Handb
http://www.cochrane.org/ ook4.2.6Sep2006.pdf

Centre for Reviews and Dissemination Handbook link

(CRD) University of York (UK): http://www.york.ac.uk/inst/crd/report4.htm
Undertaking systematic reviews of
research on effectiveness. CRD’s
guidance for those carrying out or
commissioning reviews:
http://www.york.ac.uk/inst/crd/

Evidence for Policy and Practice Methods: Stages of a Systematic review link:
Information and Coordinating Centre http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=89
(EPPI-centre) (University of London,
UK): Quality Assessment and Relevance of evidence:
http://eppi.ioe.ac.uk/cms/ http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=177
PHRED Effective Public Health Practice
Project
http://oldhamilton.ca/.phcs/ephpp/Review
sPortal.asp

Recommended for conduct of

systematic reviews

Campbell Collaboration C2-SPECTR

Database
www.campbellcollaboration.org/

5
Type of Research Website Link Type of Study - Link to Tools

Health Services Critical Appraisal Skills Programme Economic evaluation studies:

Research (CASP) (UK): http://www.phru.nhs.uk/Doc_Links/Economic%20Evaluation
http://www.phru.nhs.uk/Pages/PHD/reso s%2010%20Questions.pdf
What is the cost- urces.htm
effectiveness?
Recommended
Cost-benefit?
National Health Services Economic www.york.ac.uk/inst/crd/crddatabases.htm
Cost-utility? Database
The Guide to Community Preventive Chapter 11 “Understanding and Using the Economic
Services. Evidence” (tool):
The Task Force on Community http://www.thecommunityguide.org/library/economics.pdf
Preventive Services (US):
http://www.thecommunityguide.org/librar
y/book/Front-Matter.pdf

Clinical Practice Scottish Intercollegiate Guidelines SIGN 50: A Guideline Developers’ Handbook:
Guidelines Network (SIGN): http://sign.ac.uk/guidelines/fulltext/50/index.html
http://www.sign.ac.uk/
What is the best
intervention/
management of
….? AGREE (Appraisal of Guidelines Critical appraisal tool for Guidelines – AGREE Tool
Research and Evaluation) Collaboration
(considers the best http://www.agreecollaboration.org/ http://www.agreecollaboration.org/instrument/
evidence, context
and expert Recommended
opinion.)
National Institutes for Health and Clinical
Excellence
http://www.phel.nice.org.uk/

6
Type of Research Website Link Type of Study - Link to Tools

Overviews of The NIHR Health Technology

Critical Appraisal Assessment Programme (NHS)– Report
Methods/Tools/Pr “Evaluating non-randomized intervention
ocesses studies:
http://www.ncchta.org/ProjectData/3_proj
What is the level of ect_record_published.asp?PjtId=1117
evidence?
BioMed Central Systems article on
grading the quality of evidence and the
strength of recommendations II: Pilot
study of a new system:
http://www.biomedcentral.com/content/p
df/1472-6963-5-25.pdf

Agency for Healthcare Research and

Quality (AHRQ) (US):
http://www.ahrq.gov/

The Guide to Community Preventive Chapter 10 “Methods Used for Reviewing Evidence and
Services. Linking Evidence to Recommendations” (tool):
The Task Force on Community http://www.thecommunityguide.org/methods/methods.pdf
Preventive Services (US):
http://www.thecommunityguide.org/librar
y/book/Front-Matter.pdf

The Canadian Task Force on Preventive

Health Care:
http://www.ctfphc.org/